Exploring barriers and facilitators of regular exercise among frail older adults residing in nursing homes: A convergent mixed-methods study guided by the COM-B model

OBJECTIVES: Although numerous clinical guidelines strongly recommend regular exercise for frail older adults, adherence remains suboptimal. Among nursing home residents, exercise behaviour is influenced not only by individual-level factors but also by environmental determinants at the institutional and societal levels. However, research examining these multilevel influences on regular exercise remains limited, particularly within the context of long-term care facilities. STUDY DESIGN: This mixed-methods study, grounded in the Capabilities, Opportunities, Motivations, Behaviour model, explored multilevel facilitators and barriers to exercise among nursing home residents in Jinan, China. METHODS: The development of quantitative variables, qualitative interview guides, and analytical procedures was informed by the Capabilities, Opportunities, Motivations, Behaviour model. Quantitative data were analysed using multivariable logistic regression, whereas qualitative data were subjected to thematic analysis. Findings were integrated using a mixed-methods framework. RESULTS: Quantitative data from 20 nursing homes and qualitative insights from residents, care providers, and managers across six facilities revealed that individual-level capability (e.g., limited physical and cognitive capacity, misconceptions about exercise), motivation (e.g., exercise self-efficacy, positive affective responses to exercise, supervision and incentive mechanisms), and opportunity at the institutional level (e.g., social influence, social support, human resources, and environmental and resource support within nursing homes) significantly influenced participation in regular exercise. CONCLUSIONS: Tailored multilevel interventions considering older adults' individual preferences, needs, and available institutional resources are essential to promote and sustain exercise in this vulnerable population.